Back Pain: Is It Spinal Cord Compression?

After taking a thorough prostate cancer history (stage at diagnosis, types of treatment, dates of imaging, and biomarker studies), the oncology nurse conducts a baseline pain assessment, asking P.K. questions about the onset, duration, location, pattern, quality, and intensity of his pain; relieving and exacerbating factors; and use and effectiveness of pain medications. P.K. reports that he has had periodic lower back pain throughout his adult life but the recent pain is located higher in his back and is not relieved by lying down. He describes it as a constant, dull ache that fluctuates in intensity between 2–4 on a scale of 1–10 during the day but increases to a 7 when he coughs or sneezes and when he is lying down in bed. He has been taking naproxen with limited relief. The nurse gently palpates and percusses over the length of P.K.’s vertebrae, making note that he indicates tenderness at the level just below the scapulae. He is asked to walk back and forth a few times and also to stand still with his eyes closed, noting his gait and balance, which appear normal. To assess his leg strength, he is asked to rise from a seated position, which he does with some effort. P.K. reports that his legs often feel heavy but not numb. He needs to rest more often but is able to carry out most of his usual daily activities. His bladder and bowel habits are unchanged. However, based on P.K.’s history of prostate cancer and current reports of back pain, the oncology nurse asks the oncologist to refer P.K. for urgent comprehensive neurologic examination, including sensory, autonomic function, and reflex assessments and imaging studies to differentiate between benign spinal conditions and developing cord compression.